HIV/AIDS

Question 1

MoA: inhibits HIV integrase -> prevents proviral DNA integration into host cell genome

Answer 1

Integrase Strand Transfer Inhibitors (INSTIs)

Question 2

Lamivudine

Answer 2

NRTI

Question 3

MoA: inhibit action of the viral protease preventing the assembly maturation and release of new virions

Answer 3

Protease Inhibitors (PIs)

Question 4

Biktarvy

Answer 4

Bictegravir/TAF/Emtricitabine

Question 5

Post-Exposure PTx (PEP) recommended when?

Answer 5

• after an accidental exposure to HIV (healthcare setting (needle/blood) or sex/condom break)

Question 6

When is ART recommended?

Answer 6

ALL HIV-infected pts (regardless of CD4 count)… initiate immediately after Dx!

Question 7

PrEP options

Answer 7

• PO QD: Emtricitabine/TDF (TAF if MSM)
• PO on-demand: Emtricitabine/TDF (2 tabs after sex, 1 tab next day, 1 tab next day)
• Injection: Cabotegravir IM (dose, dose month after, then 1dose q2months)
• PO PrEP Monitoring: SCr, HBV

Question 8

MoA: elongation termination of growing proviral DNA chain

Answer 8

Nucleoside Reverse Transcriptase-i (NRTIs)

Question 9

What to combo PI with

Answer 9

• Ritonavir or Cobicistat
• PI Boosting w/ 3A4-i

Question 10

Neviripine

Answer 10

NNRTI
- dose titration over 14 days (to dec frequency of rash)

Question 11

HIV Surrogate Markers

Answer 11

• CD4 (dec levels = more compromised immune system) - useful before starting Tx
• HIV RNA (inc baseline levels = faster disease progression) - assess effectiveness of Tx

Question 12

Temsavir (Fostemsavir is a prodrug of it)

Answer 12

Attachment Inhibitors (binds to gp120)

Question 13

Etravirine

Answer 13

NNRTI
- take with food

Question 14

MoA: Bind to an allosteric site of the reverse transcriptase enzyme reducing functionality

Answer 14

Non-Nucleoside Reverse Transcriptase-i (NNRTIs)

Question 15

When to do Resistance Training

Answer 15

• at entry of care (whether ART is started immediately or not)

Question 16

Lenacapavir

Answer 16

Capsid Inhibitor (binds between capsid protein (p24))
- SQ q6months

Question 17

NRTIs AE & Pearl

Answer 17

• Mitochondrial Toxicity
• Lactic Acidosis
• Renal Adjustment

Question 18

Pre-Exposure PTx (PrEP) CI’s

Answer 18

• HIV infxn
• Weight <77lbs
• CrCl <60 for TDF/Emtricitabine
• CrCl <30 for TAF/Emtricitabine
• possible HIV exposure w/in past 72hrs

Question 19

Efavirenz

Answer 19

NNRTI
- take on empty stomach
- AE: CNS

Question 20

Corticosteroid D-I

Answer 20

w/ PI (-“navir”) + Cobicistat: Beclomethasone is preferred

Question 21

Elvitegravir

Answer 21

INSTI
- needs boosting
- take w/ food

Question 22

INSTI AE

Answer 22

Weight gain

Question 23

Genetic Barrier to resistance comparison between boosted PIs and NNRTIs

Answer 23

Boosted PIs have a HIGHER genetic barrier to resistance compared to NNRTIs

Question 24

Dolutegravir

Answer 24

INSTI
- 50 mg DAILY (INSTI-Naive)
- 50 mg BID (INSTI-experienced)

Question 25

Tenofovir Alafenamide (TAF)

Answer 25

NRTI

Question 26

Routes of Transmission

Answer 26

- exposure of mucous membrane (sex) - Blood stream exposure (IV drug use, needles) - Mother-to-child

Question 27

Ibalizumab

Answer 27

Post Attachment-i - IV

Question 28

Acid Reducers & Polyvalent Cation Supplements

Answer 28

-w/ INSTI: space apart by 6 hours - Never give Raltegravir w/ Al or Mg - Rilpivirine is CI'd with PPI's

Question 29

PI AE:

Answer 29

- GI (NVD) - Insulin Resistance - Lipodystrophy

Question 30

PEP Tx

Answer 30

- Emtricitabine/TDF + (Raltegravir or Dolutegravir) x 28 DAYS - Use precautions (condom/avoid, breastfeeding) to avoid/prevent transmission, esp. during first 6-12 weeks

Question 31

Abacavir

Answer 31

NRTI - Needs HLA-B*5701 testing before starting -- hypersensitivity rxn

Question 32

Rilpivirine

Answer 32

NNRTI - take with a meal (NOT a protein drink)

Question 33

Recommended Initial Regimens for Most People with HIV (no Hx of CAB-LA use for HIV PTx)

Answer 33

- Bictegravir/TAF/Emtricitabine (Biktarvy) (INSTI/ 2 NRTIs) - Dolutegravir + TAF/TDF + Emtricitabine/Lamivudine (INSTI/ 2 NRTIs) - Dolutegravir/Lamivudine (Dovato) (never if pt also has HBV infxn OR HIV RNA >500,000)

Question 34

At Home HIV Test/results

Answer 34

- OraQuick - Reactive Results: go to med profess for confirmatory testing - Non-reactive results: repeat test if during Seroconversion window (3months from exposure)

Question 35

AIDS Dx

Answer 35

- Stage 3 HIV - CD4<200 or OI diagnosis

Question 36

Is HIV/AIDS curative?

Answer 36

NO

Question 37

Maraviroc

Answer 37

Chemokine Coreceptor 5 (CCR5) Antagonist - test tropism before starting

Question 38

What viral load is needed for best likelihood of yielding a successful standard resistance test result

Answer 38

>500 copies/mL

Question 39

Tenofovir DF (TDF)

Answer 39

NRTI - AE: Renal insufficiency, osteomalacia

Question 40

Emtricitabine

Answer 40

NRTI

Question 41

Statins D-I

Answer 41

w/ PI (-"navir") + Cobicistat: low doses of Atorva, Rosuva, Pitava, & Prava are preferred (ARPP) - w/ NNRTIs, dose may need increased

Question 42

What website has federally approved HIV/AIDS guidelines

Answer 42

www.aahivm.org

Question 43

Benzodiazepine D-I

Answer 43

w/ PI (-"navir") + Cobicistat: preferred benzos are Lorazepam, Oxazepam, or Temazepam (LOT)

Question 44

Goals of ART Tx

Answer 44

- Suppress HIV RNA to "undetectable" - Restore/Preserve immunologic function - Reduce morbidity and prolong duration/quality of survival - Prevent transmission

Question 45

PDE5-i D-I

Answer 45

w/ PI (-"navir") + Cobicistat: use at very low doses q48-72hr

Question 46

Atazanavir

Answer 46

PI - take with food - Inc Bilirubin